Login to Access Video or Poster Abstract: MP64-08
Sources of Funding: none

Introduction

With the peritoneum acting as a natural surface for lymphatic reabsorption, many Urologists believe that a transperitoneal approach to robot assisted radical prostatectomy (tRARP) results in a lower incidence of symptomatic lymphocele (SL) formation compared extraperitoneal robot assisted radical prostatectomy (eRARP) when bilateral pelvic lymph node dissection (BPLND) is performed. There remains a paucity of evidence in support of this claim and no group has directly compared the two approaches for this outcome. Herein, we aim to determine if there is a difference in SL formation and characteristics between the two approaches.

Methods

A chart review of patients undergoing RARP and BPLND at a single tertiary care academic center from July 1, 2003 to May 31, 2016 was undertaken. Patients who underwent prior pelvic radiotherapy, concomitant inguinal hernia repair, did not undergo BPLND, or had non-adenocarcinoma of the prostate were excluded. The resulting eRARP and tRARP groups were propensity matched for age, BMI, ASA, D'Amico risk classification and total number of lymph nodes (LN) removed. SL was defined as pelvic fluid collections diagnosed by US, CT or MRI, at least 3 cm in maximal diameter, located directly adjacent to the site of the PLND and associated with pelvic pain or pressure, urinary retention, weakness/malaise, high drain output, leg edema/pain/weakness or infection in patients who underwent PLND.

Results

3183 RARP procedures were performed during this time period and after exclusions and propensity matching, 662 and 666 patients remained in the tRARP and eRARP groups respectively. No differences were noted between the groups with regards to age, BMI, operating room time, pathological stage, positive margin rate, pathological Gleason score or pathological stage. The eRARP group had higher ASA scores (p=0.0028) and estimated blood loss (EBL, 218.5±152.4 vs. 182.8±218.5, p<0.0001). The tRARP group had higher D'Amico scores (p=0.22), total number of LN removed (7.3±5.49 vs. 5.8±4.18, p<0.0001), rate of positive LN (p=0.001). SL were identified in 19/666 (2.85%) vs. 11/662 (1.69%) but this was not statistically significant. Of these 30 SL, no differences were noted between the groups with regard to initial presentation, laterality, maximal axial area on CT, hospital admission rate, treatment of SL or drain removal time.

Conclusions

The clinical characteristics of SL are similar amongst patients treated with eRARP or tRARP and BPLND. A transperitoneal approach was not associated with lower rates of SL when compared to the extraperitoneal approach.

Funding

none